It is my great pleasure to talk to you today about how to foster dignity and respect in radiology and the fact that you are all here for the first session makes me believe that you are very convinced that this is an important topic and that you want to do something about it in your environment. And I would like to give you all the skills that you need to inspire everyone in your environment to take action. So we are going to start with why this is an important topic, what actually constitutes a culture of respect, and then how are we going to implement it. So as we all know, staff engagement is very closely tied to disrespect. This is a survey that was done in 800 employees, 17 different industries, and employees who experienced disrespect self-reported a decrease in their performance, that they put less effort into their work, and that the quality of their work decreased. Also they spent less time at work. So they would not stay after 5 o'clock to finish their task. They would just leave on time. And they may even not come to work because they worry about the incident and they would try to avoid the offender. The commitment to their organizations declined and 25% even admitted to taking frustrations out on customers, which of course for us in healthcare is something that we really don't want to happen. Also the performance of teams suffers if a member of the team experiences disrespect. And this is because collaborative processes are weakened. The person who experiences disrespect will no longer use information sharing and help seeking in order to make up for some deficiencies. Disrespect is also linked to adverse events. Here is a survey of 4,500 healthcare personnel and they reported that they thought disrespect was tied to medical errors in about 71%. 27% believed that disrespect actually had caused patient mortality and 18% could quote a specific incident that they remember where an adverse event was due to disrespect. We also know that fear of disrespect is a frequent barrier to safety event reporting in about 53% of staff. And what is interesting is that only 39% of staff have actually experienced or witnessed disrespect. And what that means is that the news of disrespect that this is happening in our departments is traveling fast. And you know at the end of the day everybody will know if there was a disrespectful interaction. So how about patient outcomes? This is a study from the surgical literature where at one institution people from healthcare quality looked at the performance of a surgeon tied to how many complaints about that person being disrespectful they had on file. And they found that the incidence of wound complication was very much tied to how disrespectful a surgeon was. So worse outcomes in surgeons who are disrespectful to their staff. And all of this has a significant impact on costs. Malpractice suits but also losing staff, having to train new staff, and all the human resource efforts that go into dealing with disrespect are actually responsible for about $6 billion per year in the United States spent on dealing with a fallout of disrespect. Well you may ask why are we dealing with this now or why is this now urgent? Well disrespect is on the rise. In this study, again looking at industries across the United States, you can see that from 1998 where about 25 percent of people experienced disrespect in their environment on a weekly basis, this more than doubled by 2011. And in our own institution, unfortunately we've seen a similar trend. We had asked about yearly disrespect but you can see from 2015 to 2018 where it was about 67 percent, that is a tremendous increase. And this trend has been recognized by the Inter-Society Conference this year when they came up with a statement on professionalism that specifically states respect to be one of the core features that a radiologist should have. And there are societal reasons for the rise of disrespect. I cannot go into it in great extent but with an increase in workload that we all experienced, our workplace relationships increase in complexity and we are very fragmented. And also communication technology, while that is a benefit, we haven't really worked out yet what is respectful communication in email or on social media. And when we're using these communication technology more and more, our interpersonal skills actually decrease. And there's also a change in expectation of behavioral norms. While we have to some extent gotten accustomed to some behaviors that are maybe borderline, there is now an increased awareness that that is not okay and we have to be sensitive to the cultural diversity in our environments, actually realizing that some behaviors that are acceptable in one culture are not in another. And again, we have not worked that out yet. So what does a respectful culture actually look like? When we look at the definitions for respect, we're talking about actions that honor and acknowledge dignity, dignity being the intrinsic and unconditional value of each person. And when we're talking about actions, we will talk now a lot about behaviors and this will get quite granular and it has to be so that we can make changes. And for culture, when we talk about beliefs and customs of a group, we will also need to talk about the needs of the individual and what they need from a group. So we started out with a survey of our employees and we asked them what they consider as respectful and disrespectful behaviors and then grouped them into major themes. And you can see what comes out at the top here is active listening with 45 percent. 40 percent mentioned a team approach to work, appreciation, acknowledging the individual, and a positive work environment for others. So let's go through them. Acknowledging the individual for respectful behaviors, what people mentioned was being greeted, so saying hello. We instituted the 10-5 rule, which means at 10 feet you smile and at 5 feet you say hello. And this has really made a huge difference. You can see this in the hallway when people greet each other and it does create a different energy. People felt that knowing the names of your coworkers is very good if you work with them a lot. Of course, in a department of 600 people, you cannot know everybody's name and people are understanding of that. But when we're thinking more about acknowledging the individual, what that actually means in a deeper sense, it is about connectivity. So it is about connecting one-on-one, connecting with your team members on a human level and creating a sense of belonging. For active listening, we all know there are close communication scripts. We all have been taught how to do them. Everybody is aware, but again, there is something deeper that people are asking for here. It is really that we are listening with the intent to understand. Stephen Corby says we are listening with the intent to reply, and it's not so much with the intent to understand what the person is actually saying and what they mean. So we have to pay attention to acknowledging what was said, to making staff feel heard when we do that, and to genuinely value each other's opinion, maybe by something as simple as saying good point afterwards. How about a positive work environment? So the single respectful behavior that came up all the time was assuming positive intent. And what that also comes with is making no assumptions and not jumping to conclusions. That alone was seen as being supportive of your staff member. It's the most important leadership skill, according to Brené Brown from the book Dare to Lead, and she says that 50% of leaders assume positive intent, which I actually think is a huge number, if that is true, because it is so difficult. As humans, we are trying to put information together quickly, and we are making assumptions, we are filling in the blanks of what we don't know, that is normal behavior. And if 50% of leaders do not make assumptions, that is great, but of course we want to improve on that. There was something else that was interesting about the positive work environment, and that is actually that we're looking here at the behaviors that were mentioned. Most of the behaviors in this group was actually people mentioning disrespectful behaviors. So what this means is that in terms of creating a positive work environment, what we really need to do is to stop the negativity in the workplace. And what is that? Well, it is blaming others, it is talking behind people's back, publicly criticizing someone and making assumptions and generalizations. And as leaders, that is a behavior that we do have to model, and only then can we move on to focus initiatives for change. And I cannot go into this in detail, but you see on the bottom here, Glenn Rolfsen, he is a social psychologist in Oslo, and he gives a 10-minute TED talk on this topic, and this is very much worth spending those 10 minutes and listening to the talk. It's actually very straightforward to work on that and to eradicate it, and he has done it in multiple institutions. The next topic is appreciation, and it sounds so simple, but it's actually really difficult to get this one right. Lack of appreciation is the second leading cause of burnout and stress, and in fact, people who leave institutions in 79%, which is a huge number, resign because of lack of appreciation. So this is something we definitely have to work on. There are two major ways of doing it. One is called the recognition practice, where in the moment we say thank you and excellent job, and another one is recognition programs. I'm sure we all have that, employee of the month, spot bonus, other things of appreciating people. But when you look at the impact of these two methods, it's interesting that the in-the-moment recognition practice is three times more effective in terms of making a person feel appreciated than the recognition program. And actually, the recognition can come from a peer. Peer praise, 76% of staff feel very much appreciated when that's happening, and manager praise is just a little bit higher. How about a team approach? In a study of high-functioning teams, we actually will find all of the things we've already talked about reflected, that in high-functioning teams, positivity is really important. So positive to negative statement ratio here is five to one. Just as an aside, that is also the positive to negative statement ratio that has been found for successful marriages. So what does this mean? We are supportive in what we're saying, encouraging, we show appreciation. Also, the inquiry to advocacy ratio, which means that we're asking a person for clarifying what they mean. Basically, active listening is balanced at about one, and it's very low, as you can see, in the low-performing teams. And of course, connectivity is also much higher in high-functioning teams. All of the elements of a culture of respect. So now, how do we put this into practice? In three not-so-easy steps, I should say. We first have to define what we actually, what our culture is about. We started with a staff survey panel and group discussions. You do want to get input here from your frontline staff, because you want them to feel respected in the end. And then we will implement and reinforce. For implementation, well, who would you direct that at? Interestingly, here's our survey. Everybody is involved in disrespectful behavior, as you can see. But then some groups more so. So attending physicians and managers and supervisors are the most disrespectful people in our department. That is, of course, not because they are inherently disrespectful people. But as literature shows, if you are in a hierarchical relationship, whatever you do in terms of behavior is amplified. So every behavior that a leader shows has a very different meaning than when it comes from a peer or somebody who is working for you. For implementation, if you want it to be an interactive way of doing that, you will have to start at the top. So you start with your leaderships and train those. And then you move on to frontline staff. But you can also go other ways with online modules and flip cards, for example. But reinforcement will be key. So individual feedback to staff on events goes a very long way. And if you haven't had a chance to see Alex Tobin's poster on respect, I would recommend that you do that. Because they had fantastic results improving their interactions, positive interactions from 45% to 90% by giving individual feedback. You need, of course, other ways, a program to address disruptive behavior. And we should really start thinking about recruitment for civility, which many institutions don't do yet. And in the end, what's in it for us as individuals? Well, interestingly, respectful people are perceived as warm and competent. And they have better outcomes, probably because of improved communication. They're seen as leaders, and their teams are performing better. So in conclusion, fostering a culture of dignity and respect is mandatory to improve all the things that we care about. It requires identification of behaviors and core values that build our culture. But it needs thoughtful implementation and dedicated maintenance. But in the end, we will all benefit. Thank you so much for your attention. So talking about mentoring and sponsoring, how many people in this room have a mentor or a sponsor or both? How many are mentors or sponsors or both? Now I'm wondering, the people who didn't raise their hands, how many of you are feeling burnout? How many of you are thinking of going part time? How many of you are thinking of leaving radiology or leaving medicine? Because we have a problem in medicine with a lot of people checking out. They're either feeling burnout, they're thinking of retiring early, they're thinking of going part time. And one of the reasons is because they're not engaged. There's been a lot of research on this. This is a study that Deloitte does every year, where it surveys millennials about their workplace culture. And they found in 2016 that two-thirds of millennials were thinking of leaving their current positions within four years. Now that's across all different types of employment, but we see that in medicine too. And some people have called this the loyalty challenge that we see with millennials. But when you dig into this data deeper, you find that those who intend to stay with their current employers are two times as likely to have what they would describe as an effective mentor. They also say that when their leaders support their own leadership ambitions, they're more likely to stay. So I would ask, is the loyalty challenge with our employees, with the millennials, or is it with us in engaging them to stay? And I think that if we mentor our employees, and if we sponsor them for leadership roles, they're going to be more likely to stay. And so I'm going to talk for the rest of the time about how we effectively do that. When we want to grow the next generation of leaders or the next generation of star employees, we have to first start by identifying the top talent. Then we want to develop their skills. We want them to be so good that they have the opportunities to leave us, but so happy that they will continue to stay with us over the long term. And that's how we're going to retain them. So when I am looking for people to join my team, the things that I look for are, have they demonstrated a multi-year commitment to something? Have they sustained change over time and demonstrated advancement with their achievement? Or do they make lateral moves fairly frequently? Have they bounced back from failure in the past? We're all going to have failures. Do they persist? Do they pick themselves up and go on? How do they deal with obstacles that they encounter? Do they have a habit of self-improvement? And what is their purpose? Is it bigger than themselves? And does it resonate with my team, with my organization, and with our larger goals? I would sum that up by something that I would call grit. I'm looking for people who are passionate about what they do, who have the patience to continue the hard work day after day, and persevere through the obstacles that we all inevitably encounter. But identifying the top people's not enough. Once we've done that, we need to align their skills with our organizational goals and objectives. We want to set high expectations for them, but then we want to give them the skills and the resources to achieve those expectations, establish psychological safety and trust, build that respect that we just heard about, and ensure that they have the resources to take on appropriate risks, to make mistakes that they can learn from, and that they can continually grow throughout their careers. And we do that through mentoring, coaching, and sponsoring. And I like this slide because it gives a nice, succinct description of what each of these roles is. And I borrowed this courtesy of Christy Latchaw at Vanderbilt University, and it describes really quickly that a mentor is a trusted, long-term partner, someone who's with you over the long haul. A coach is a shorter-term advisor, somebody that's very focused on goals. And a sponsor is a future-thinking advocate. And advocate is the key word. If we dig into each of these in a little bit more detail, we'll start with the coach. As I mentioned, the coach is a short-term advisor. They help you with a task or a problem that you're trying to solve. In my organization, a new department chair will likely have a coach to help them transition from what may have been a lower leadership role to now this enormous responsibility for the entire department. Sometimes we'll use experienced individuals from within the organization to do that coaching, and sometimes we'll hire a professional coach from the outside to do it. It can be done either way. A mentor, and the word mentor comes from the Greek. It actually comes from Greek mythology and the Odyssey. In the Odyssey, when Odysseus went off to fight the Trojan War, he left his young son Telemachus behind with his trusted friend, Mentor. And Mentor helped guide and advise Telemachus so that he could grow and assume the family responsibilities while Odysseus was off fighting the Trojan War. So a mentor has a mentee, they are trusted, they've built that strong trusting relationship with their mentee, and they're a long-term partner to help guide that mentee over the course of their career. They give advice and they give guidance. And importantly, they transmit cultural norms and expectations. They really help the mentee navigate the organizational system. And they foster career development over the course of the mentee's career. A sponsor has what we might call a protege. They are a future thinking advocate. What does that mean? That means they give their protege opportunities and they open doors for that individual. They get you a seat at the table where things happen. And importantly, for you might be asked this at a later time, the protege may not always know who their sponsor is. These people may be recommending you when they have a seat at the table behind closed doors. So you don't always know that they're acting on your behalf. All three, coach, mentor, and sponsor, believe in your potential. They often see your potential when you don't see it yourself. They support you in achieving your goals. And once you've achieved them, they will champion your successes. So to sum it up, I get asked frequently, what's the difference between a mentor and a sponsor? A mentor advises and a sponsor acts. A mentor talks to you and a sponsor talks about you, often behind closed doors when you're not in the room. Now a lot has been said about women and underrepresented minorities with respect to mentorship and sponsoring. And research shows that these individuals are likely to be relatively over mentored and under sponsored. Women in particular get three times as much mentoring as they get sponsorship. And men are 50% more likely to have a sponsor than a woman is. Some of this is rooted in unconscious bias. As human beings, we're naturally drawn to people who are like us. And as many leadership positions are held by men, they're drawn to other men. So you have to be intentional about creating inclusion. And sponsorship is a very effective way to do that, to cultivate our diverse organizations and to minimize an insular way of cultivating talent. So an additional way to think of the difference between mentoring and sponsoring is that mentoring helps an individual traverse the organizational maze, but sponsoring helps to change it and create both diverse and inclusive organizations that can meet the innovative challenges that we're facing in modern medicine. So as a mentee, you want to have multiple individuals on your advisory board. And Geraldine McGinty wrote a nice article about this in JACR, where she talked about mentors and sponsors and creating your kitchen cabinet. Basically creating a sounding board of advisors that we can all use throughout our careers to help us achieve the success that we're looking to achieve. So you want to find individuals who see your potential, who see potential in you that you may not recognize yourself and help you to see that. It's important to have someone who has advanced further than you in their career, someone senior to you that can help you with how to negotiate the realities of that career. They've been there, they've done that. You also want to have someone who's younger than you on your advisory board, someone whose vision is not encumbered by the scars and realities of having negotiated a career. You want individuals who can be brutally honest in giving you feedback, but you want to make sure that they have your best interests at heart as they do that. And you should ideally have at least one individual in your inner circle who disagrees with you on most things. You do not want to surround yourself by yes men and yes women, because you're not going to grow unless you get that kind of feedback. Peer mentoring and coaching has been found to be a very effective way to minimize burnout, particularly in medicine. We think of our peers as having equal skills to us, but if you look at the people that you work with, you may have someone who's much better at running or organizing meetings than you are, and maybe you're good at motivating people to get things done. You can coach and mentor each other to be better at some of those individual skills. So some best practices when you're a mentor. The most important thing is to build a rapport, to build trust with the people that you're mentoring, because that's the only way that they're going to be able to hear the honest and sometimes tough feedback that you're going to give them. Make sure when you give them that feedback that it's always with the intent to build them up and not with the intent to bring them down. Make sure you understand what the mentee's goals and objectives are. Be sure to elicit those so that you're helping them down the right path. And allow the mentee to say no if the advice you're giving them isn't going to advance their career in the direction that they want it to take. Failure happens to everyone. As a mentor, you want to try to intervene before your mentee totally crashes. Try to address missteps before they happen and do it directly and candidly. Remind your mentee that failure is common. It happens to all of us and the best of us. Reframe it as an opportunity to learn and grow. I have seen recently that FAIL, F-A-I-L, is an acronym for first attempt in learning. And I think looking at it from that positive perspective is important. And then importantly, let the mentee know that even though they may have had a failure, you still believe in them and you still believe in their potential. So that they will pick themselves up and continue to go on. I want to spend a minute talking about what has been called mentoring malpractice. And that's really when the mentor is not living up to their obligation to the mentee. It may be because the mentor doesn't really have the experience to advise the mentee. In those cases, maybe find a colleague that has the appropriate experience. Your mentee can have multiple mentors and it's important to find them the right one for their specific goals. Mentoring should advance the mentee's career. It's not meant to be a mechanism to advance your own career. So don't exploit the mentee for your own personal gain. Yes, you may benefit too, but the primary goal is that their career advances. You may have competing priorities to mentorship. And assuming positive attentions, everyone wants to be a mentor and be a good mentor. As you advance in your career and have other obligations, you may not have time to take on as many mentors as you did earlier in your career. If you don't have the time, don't agree to do it. Make sure that you're going to be able to give them the time they need before you say yes. And then finally, as your mentee grows in their career, they may become equal to you or even surpass you in that particular skill. At that point, it's appropriate to end the mentor-mentee relationship and enter into more of a peer-to-peer relationship so that real or perceived competition does not become a problem in the relationship. I'd like to at least address the Me Too issue. I see many men in the audience, and I've heard that there are concerns about older men mentoring younger women in the Me Too environment. I would like to first reassure you that being falsely accused of sexual misconduct is exceedingly rare. I've heard statistics that it's on the order of being struck by lightning, so very unlikely to happen. But if you want, and assuming positive intentions that you do want to mentor women, a few tips to help you feel confident that you're behaving appropriately. In any mentor-mentee relationship, you want to keep your behavior professional at all times, in public, in private, whether you're being observed or not, in email and text communications. Don't communicate anything that you wouldn't share with all of your colleagues or that you wouldn't share with your significant other. In some cultures, it's appropriate in large social settings to greet someone with a hug. Other than that, refrain from physical touch. Don't mention physical appearance, what somebody's wearing. Don't make generalizations about gender. And I think most importantly, speak up to support women. Speak up when your male colleagues may not, and particularly speak up when they may be speaking out against women. And sponsor and mentor women into leadership roles, because there are many talented women out there. What if you're the mentee? What are some best practices? It's your responsibility to drive the relationship, because you're the one that's going to benefit from it. Be honest and clear with your mentor about your goals, so that they give you the right advice. Be prepared for meetings. Be respectful of your mentor's time. They're busy people. They want to help, but they want you to be prepared when you come. Stay connected with your mentor in between meetings. Follow up regularly to stay on track. If you're having trouble, reach out for help. That's what they're there to do. And then be willing to stretch out of your comfort zone. The goal is to continue to grow and learn, and you're not going to do that unless you step beyond your comfort zone. And then lastly, thank your mentor. And you can do this in a number of ways. You can take them out for a cup of coffee or lunch. You can send them a thank you note, and written thank you notes are very much appreciated in this electronic world. You can give them a public shout out on social media in a meeting like this. I've been fortunate to benefit from the sponsorship of Dr. Geraldine McGinty. She's helped me to advance in my leadership roles at the ACR. So publicly, I would like to thank her for that. And then lastly, I think one of the most important ways you can thank your mentor is by paying it forward and being a mentor yourself. Because that helps to exponentially grow well qualified, well trained, and well engaged employees into the future. I like this quote from Amemi Umana. She was the first black woman after 130 years to be elected as president of the Harvard Law Review. And when she was asked about her success, she said, you are not successful until you brought the next woman up. It's not success if it's just you. And I've put woman in brackets because we could fill anything in that space. You're not a success until you brought up the next neuroradiologist, or the next quality and safety expert, or the next division or department chair. You're not successful until you've brought somebody up behind you. So I would encourage you all to be mentors, and to be sponsors, and to help grow the next generation. I promise you that you will not only lift them up, but you'll lift yourself up in the process. Thank you. So are interruptions a problem? Well, it sure feels like it, doesn't it, when you're in the reading room? I mean, we get daily complaints from people. That phone never stops ringing. How can I get any work done? It increases stress levels in the reading room. We have to remember that radiology is a very complex cognitive task. So when we get interrupted, different things happen. It disrupts our search patterns. We may lose our place in the study. We need to stop and restart this sort of complex task, which takes time. There's a lot of evidence out there, a lot of it in the business literature, but a lot of evidence in psychology literature and other places, looking at interruptions and how they actually affect people's performance. I just cherry-picked a couple studies here. The first one's a study that's actually from psychological literature. They took students, essentially, and they said, we want you to do this task, which was read an article on psychology, just whatever article it was. But in doing so, they split them up into three groups, and they basically said, group one, we want you to do an instant messaging task before you read the article and then take a test on the article. Group two, you're going to instant message in the middle of the article and then take the test. And group three, you're just going to read the article and take the test. And what they found, and this could be a SAM question, was that during the group, so the people who actually IMed during the task, so while they're reading the article, took significantly longer to read the article. So the task took them longer to complete. And that actually excluded the amount of time they spent while they were actually IMing. So even if you accounted for that, it took them significantly longer to get the task done. Looking at the radiology literature, there's a study actually out of Indiana University where they looked at on-call residents, and basically they tried to correlate discrepancies so that morning after read where the attending says something different than what the resident said in a prelim with the actual volume of phone calls that came in over the night. And while they found a non-significant increase in discrepancy rates with more calls, when they looked at that hour before a major discrepancy occurred, they saw that there was actually a significantly larger number of phone calls the hour before that discrepancy occurred, sort of implying that maybe that resident was stressed out or distracted when they started to read the study that had the discrepancy. So are interruptions a problem? I would argue yes. They decrease our efficiency, obviously, when we stop and start tasks. They increase stress levels. And then there's a possible increase that they may increase our error rates as well. So we just need to get rid of all interruptions, right? It's very easy. Just lock ourselves in a room. We'll never have to worry about it. But as with everything, there's kind of two sides to every coin. And for this problem, the other side is really collaboration. So collaboration is really the counterbalance to these interruptions. And so the question becomes, do we need collaboration? And I would argue yes. And if we look at these different groups that I've listed here, they've all sort of argued yes as well. For those of you who went to the president's address on Sunday, you know, Dr. Jackson talked specifically about collaboration, collaborating with patients, collaborating with colleagues. The ACR has stressed this with their Imaging 3.0 program. Clinicians, I would argue, usually say they want to collaborate with us. Some sort of prickly ones don't. But in general, they say they do. Patients, when we've asked patients if they'd like to collaborate with a radiologist, they say yes, typically. And then it just feels like it's the right thing to do for patients as well, to collaborate. We all know we provide better care when we can actually talk to the referring clinician and really understand what's going on with the patient. So looking at collaboration, there's really four practice types. And this is an article by Gunderman out of Indiana, who talks about these different practice types. And again, any times there's four things, it may make a good SAM question, so you can pay attention to this part. But he talks about the isolated radiologist, the available radiologist, the eager and the embedded radiologist. And I think I'll go through and describe these, and you'll kind of see yourself in some of these. So the isolated radiology or radiologist practice would go by the quote, I work best alone. They create distance from their referring clinicians and patients, whether that's real distance by being in an office park somewhere, whether that's imagined distance just by having a locked door or some sort of closed off space. It's relatively difficult to communicate with them. They may have cumbersome technology that just doesn't work, still using pagers that are very inefficient or something like that. And then when you actually do get a hold of them, and they can be inhospitable or even frankly hostile. You know, what are you doing here? Get out of my reading room. I got work to do. Now these people are relatively efficient because they don't have as many interruptions. And it's very easy to measure their output because you know what they're doing every minute of their day. They're reading studies. The available radiologist is what most of us probably will recognize. And that's sort of this model of I will help if I'm asked. So if someone comes and asks me a question, I'm more than willing to help. They're easy to find. Usually they're physically close to your reading room, maybe in the hospital, somewhere in a central location. There may still be a layer of distance, so a phone tree, a reading room coordinator that someone has to go through in order to get to you. But the interactions are usually initiated by the referring clinician. So someone comes down to the reading room, someone calls into the reading room. We're rarely going out from the reading room. So really these interactions are very reactive. Stay as close as possible, or stay as focused as possible on production. So you're focused on production, but when you do have an interruption, you do stop your task and deal with it. But you really are still focused on production and output. And this is by far the most common radiology practice type. I think we probably all recognize this practice type. Then he moves on to talk about the eager radiologists, and the eager radiologists' quote would be, I will ask to help. They usually are in a very convenient physical location. It's very easy to communicate with this person. They may actually actively seek to build relationships with clinicians, may actually have interactions directly with patients, and with this comes less of a focus on production. And it's kind of harder to measure what they're doing with their time, because the time spent talking to patients, time spent talking to referrers, reaching out to referrers, isn't necessarily an easily quantifiable metric like an RVU. And then finally on the far extreme is the embedded radiologist, and this is the radiologist who says, I'm on your side. They're integrated as a member of the care team. They provide a real-time contribution, so they may be physically embedded in a clinic, for example. There's no physical distance, so again, a decentralized reading room, maybe you're in clinic or you're going on rounds with people. The problem with this, though, is there's limited production. All that time that you spend in direct collaboration isn't necessarily time you spend interpreting studies, and it's really difficult to measure how your time is spent. So it's important when you think about these different practice types to realize that they're not sort of set in stone. They could change throughout the day. If you think about your average day, there may be times when you're collaborating, you're giving a tumor board, and then other times where you're the resource person and you're kind of locked away somewhere, different things like that. And there can be multiple models in any given practice, so if you have a large practice, you may have some people who are more on the eager side and other people who work better in that isolated model. I think we all have aspirations to kind of be in that eager category. That sort of feels like what we want to be. If we go as far as the embedded category, I think there's some significant challenges that other people have described when they've tried that model. So how do we balance interruptions and collaboration? Is it even possible? And so what I want to do for the rest of the time is talk about our experience at Cincinnati Children's. So Cincinnati Children's is a large academic pediatric hospital. We have 35 faculty pediatric radiologists, about 190 technologists, and then you can see they're anywhere at any given time between, let's say, 10 and 15 trainees, fellows, and residents in the department. Our main reading room is kind of this L-shaped reading room that has these four pods that come off of it. And there's one specific reading room that we call the trunk reading room because it's basically the body reading room. That's also where the residents take, or fellows take, call. It's always sort of the central go-to place in the reading room, and so that's a very busy place. It's a place people don't like to work because the phone rings constantly. People are interrupting it constantly. And so what we wanted to do was actually look at that area, look at that specific reading room, and try to reduce the number, really optimize the number of interruptions that came into that reading room. So the first thing we did was we built a team. I was the project leader, and then we had an operations specialist. We involved our technologists because they're the ones who are often initiating interruptions for us, reading room coordinator because they're kind of the front line there, and then also another radiologist. And then we just basically collected baseline data and started working, and the way we collected data was actually a sample. So we had a person physically sit in the reading room one hour a day during specific times, certain work days, and just physically record how many times someone came into the reading room to interrupt us, how many times the phone went off, how many times a pager went off, and we actually recorded the time between those two interruptions because if you think about it, that's what you really want to get at. How long do you have between interruptions to be able to do your work? And so this was our baseline data. I know the numbers are a little bit small there, but you can see it. We sampled for about a month, and what we found was our median time between interruptions was 187 seconds, which is just over three minutes, which if you think about it, throughout the day, being interrupted just every three minutes is really, really not a great situation. So we looked at this and we said, oh my gosh, this is way worse than we thought it was. So what did we do then? Well, we sat down and we tried to use quality improvement methodology to look at this problem and to actually improve the reading room environment. And so we made these complex process maps, and on the left is actually the process map just for if a phone call comes in. Then we had another one for if someone comes and visits, and another one for pagers. So I just put that up there just to show you how complex this problem could be. But what we did was really then broke it down to these different areas. So an interruption's considered, an interruption occurs, it's triaged, the radiologist gets interrupted, the question's answered, and then you resume reading the study. And that's sort of our basic process map that we worked from. We looked at basically what all failures could we have, and we got to get in a big room with lots of Post-it notes, and we came up with this failure effect analysis, and then we also looked at a Pareto chart to kind of figure out where our main problems were. And we sort of had these top three problems that we were looking at. One was just phone calls coming in constantly. The other was image checks, which was something that we had sort of expected, but we traditionally had lots of different types of images that we required to be checked for historical reasons that nobody even remembered. The other big one was clinical questions, but we decided that in balancing collaboration we weren't going to try to tackle that one just yet. We decided to focus on these first two. So we put together a key driver diagram. Basically, again, this is a little hard to read, but the things we really wanted to focus on were looking at image checks. Are there historical things that we do in the department that there's really no reason to do anymore, and can we improve those or decrease those? And then also looking at some technology solutions. So our phone, for example, would ring in multiple locations at once, and nobody really knew why. The phone tree had kind of been cobbled together over years. So we wanted to look at some technology solutions to try to really fix that. So we did this for six months. We did multiple different PDSAs looking at different things we could do to try to reduce these interruptions, increase that median time between interruptions. And this was our run chart at the end of the first phase of the project. So you see we did reach our goal, and we increased the median time between interruptions to 336 seconds, which is actually a 79% increase, which seems good. But then if you think about it, it's still only a little over five minutes, which is not ideal. So we threw a little pizza party, of course. Notice it's cheese pizza, not pepperoni pizza. We got to get it a little bit more before we put the pepperoni on there. And then we tried to look at our data in some different ways. So we looked at weekly means, because if we go back to that initial run chart, you can see there's a lot of variability and a lot of data points there. So we tried to kind of break it down and see if it was a little easier to understand if we looked at weekly means. Didn't really help us all that much. And then the chart on the right is actually the number of interruptions per hour, which you could see there was also a shift there and a decrease in the number of interruptions per hour. So what we did then was we kept working on this problem, but we actually went back six months later now and looked and did a two-week sort of spot check to see how we were doing. And actually after six months, we had sustained improvement, which was good. We hadn't actually moved the needle any further, but we did have sustained improvement with our median still being 336 seconds between interruptions. So what are some take-home points here? I think the big issues are that interruptions can be a real problem. They are a real problem. I think there's scientific evidence to back that, but we have to balance that with collaboration. And so we have to think about what kind of radiology practice do we have now, what kind of radiology practice do we aspire to be, and how are we going to balance those two things out? Quality improvement methodology can be used to reduce interruptions, and I think this last point was really what we learned. Instead of immediately going to the idea of outside forces or what's making our reading room busy and hectic and different things like that, it's important to look at your own house first. Look at your own department. Look at what you're doing, your processes. See if there's anything you can work on there first before you start locking your doors and saying, go away, clinicians, we don't want to talk to you, and being the isolated radiologist. Because again, we really do have to balance interruptions with our ability to collaborate with our colleagues. Thank you. I think this is an important topic for a lot of reasons. Most people in this room are healthcare workers because they care about people. And people is a plural word, and I think you're all people, too, and sometimes we are going about trying to help other people. We actually end up hurting ourselves. This is one example here. I was at a conference about six months ago, and I came home, and my son, Quinn, put this on my vanity. He says, I want to see my dad, and I want to tell you something. From Quinn to daddy, P.S., I miss you, and there's a heart. So I learned two things. One is he likes me, and two is he wants to see me more often. So this was about six months ago, and so I asked him, maybe you could come with me to the conference and stand up here and tell the audience what kids think about their parents going to work. And he said, daddy, I have school, so I can't do that, but you can videotape me if you want. And so I decided to do that. So here's Quinn. This is our first attempt at audio, so I'm praying to somebody in the sky that this works here. Quinn is six years old. He's pretty wise. He doesn't look like it, but he is. Let's give this a shot. I think daddy does a good job at work because he's a doctor, and he helps people who are sick and need help, and yes, I do get to see my dad almost all the time, and let's see here. My advice for other doctors are don't be nervous to meet new faces. Just make new friends, and never be shy. Just speak up if you have something that you need to say or if you just want to say something. Then just go ahead and use that. Isn't that great? So he was, yeah, right, good, nine years old. This might be the first nine-year-old who's ever given a presentation at RSA, by the way. So in some of those prior talks, they were emphasizing things like collaboration. So if you feel chained to your work desk and that soulless experience of reading and signing and reading and signing, and you're skipping your lunch break, Quinn would suggest you should get up and talk to your neighbor. Now Quinn's nine, so you may not give him a lot of credence, so I'm actually going to ask my wife next what she thinks. She was in HR for 10 years. Now she's a stay-at-home mom, and let's see if we can stop this here. There we go. So now she's a stay-at-home mom. So she's been with me for 23 years, so she knows me very well. And she's got a video here, and I'm going to tell you a tip. So about halfway through, she's going to itch her upper lip, and that is a tell. I've learned this over 20 years. That's when she's lying. So about halfway through, she's going to itch her upper lip there. So you want me to talk about your work-life balance? Can I just go with what Quinn said? Just kidding. I think it depends on what your perspective is personally, where your priorities are. So many people, their work is their priority, and so it's hard for them to have a work-life balance because work always takes a priority. I know that you try to balance your work time with your family time, and you generally do a pretty good job of that. There it is right there. I know that you try to do less work at home in the evenings on the computer, but then that translated into you having to do phone calls in the evenings. And sometimes it was a lot of phone calls, and then you said, okay, I'm cutting off work phone calls at night, but now I see you texting a lot in the evenings. And in the position that you have, there's only so much that you can get done in a work day, and some of it has to be done in off hours. So for us, you balancing your work-life means that, yeah, you're going to have some stuff that you have to do at home in the evenings, but then you also have to make time for family stuff. And I think you do a good job of that. Weekends are typically time when we do stuff all of us together. And I don't get as many questions as I used to about, you know, where's daddy? When's daddy coming home? Is daddy off the phone? Where is daddy anyway? So she has a little different take than Quinn does, but I think in every situation, these kinds of things are individual. So how I choose to balance my life is absolutely going to be different than how you do. And it's not just as simple as, is it academics or is it clinical care? There's other more deep things here, like what you value, what your soul is, what your impact is in healthcare, whether you're going to change healthcare for the better, what your self-worth is. Those are the things that feed into this balance equation. And balance requires an answer, in my opinion, to this question, is who are you and what do you value? And that informs the decisions that we make when we're choosing between things. So this is just an opinion. So how should we figure out what to do? I think we should start with, what are our core values and our principles and ideals? And we take those and use them to inform a series of options that we're considering. And those options may have different facts. So if I'm choosing between doing a research project or spending time with my family or doing an extra teaching session after work, those are individual things, but I'm using my core values to inform that decision-making process. And from that, I'm going to arise at a sound and wise decision. So these are all going to be clouded by things like extrinsic pressures, so your friends or your mentors or your family who are suggesting things to you to do, and also things that are internal to you. Maybe you have a legacy component to your life, or maybe you're afraid of either success or failure, or you have a perfectionist streak. And of course, predicting the future is hard because we don't have all the information we make a decision, and also once we make a decision, everything continues to change after your decision is made. The world is not waiting to see what happens to you. But I think how decision-making often happens is that we start first with considering the individual facts of the options in front of us first, without letting our core values and our principles come into play. Those get muddied up, again, by these extrinsic and intrinsic pressures, and the fact we don't have all the information available to us, and that makes us toss around a little bit and we sort of churn. We don't know what to do, and it stalls out our decision-making process. And what we end up with is a shaky sort of hope for the best decision here, and then lurking in the background are those core values and principles and ideals. So I keep mentioning values, and you might say, well, what does that mean, when we say make a decision based on values? I actually just wrote mine out. Sometimes when I meet with mentees, I ask them to do the same thing, is write down a list of the things that you value. So here is the recipe of me, and I'm sharing this from my perspective, because, again, I believe that life balances all a very individual thing to individual people. So here's mine, and if you want to manipulate me, all you have to do is take a photo of this and then convince me, using these core principles, and I'm just going to do whatever you say, because you know this is the core of my identity. I believe that life has value, that other people come first, that I should always tell the truth, that strife is failed diplomacy. I want to address what I can control. I believe we're a long way from perfection. I believe that effort trumps talent, and alliances trump aggression. I believe that wealth is a means, not an end. I want to know the truth, but I want to focus on what's positive, and I want to do the right thing. So these inform my decisions. So when a series of options come up to me, I plug these into this equation and say, what should I do? So I'll show you four examples of this. Here's an opportunity that one could consider. I could put out personal sacrifice to do a research project that spends a lot of my free time at the expense of other parts of my life, and I believe that doing that will improve health care. So if that's the equation, I'm going to consider my principles, and here's what they are. So these values feed into this decision-making process, and based on the fact that I believe that life has value, that other people come first, that I should address what I can control, and I should do the right thing, and that we're a long way from perfection, those values inform my choice, and I'll say, OK, I'm going to do that research project. Now let me show you an example on the other side. Let's say someone offered me a lot of money to go read in a practice where I need to read as fast as I possibly can. Now for me, this is an individual decision. I would plug these values and say, well, if I believe that by doing this I'm actually contributing harm, then that would make it hard for me to say yes to that job, because I believe that life has value, that other people come first, that I should do the right thing, and for me personally, wealth is a means, it's not an end. So I use those values to make a decision to say I'm probably not going to take that job. Here's another example. If the option here is to work collaboratively to improve IR and surgical relations, if I plug in these values, I'll say, gee, these kind of align with what I think I should do, so it's worth spending my time on doing this activity. And the fourth and final example is I could publish a bunch of papers that are relatively low impact and make my CV very long, and this is a compelling thing that a lot of people in academics feel pulled kind of to do. And I would say that based on my value structure, this is not worth my time, because other people come first, I should do the right thing, life has value, including my own, I should address what I can control, and so based on these things, I'm going to decide this is not something that I should do. So another way to consider this is the whole thing of like this is how you should be successful actually has no inherent meaning. So if someone ever tells you this is what you should do to be successful, be skeptical of that, whatever comes to follow, and this is a colleague of mine who I work with, he's the Associate Chair for Quality and Safety, his name is Prasad, and he wanted me to label him as a part-time robot, full-time dad, and this is his take on this topic. Trying to tell people how to be successful in academic medicine, academic radiology is really hard, because success looks totally different for different people. For some people, success is having a high impact and meaningful education. For other people, it's all about the research, and for other people, it's clinical care first and foremost. And there are those that it's a combination and different distribution of those things. So trying to understand a single prescriptive pathway to success in academics is not going to work, because each individual is different. As far as some concrete pieces of advice, I would say, always remember that time is a zero-sum game, and it's the most important commodity that we have. Any time that you devote your time towards one activity or another, that's time you're taking away from something else. So I think trying to understand what to do or how to be successful really comes down to understanding what you want to do or what your North Star is, and trying to cast as many votes as you can towards that direction. To that end, the other thing I would say is, don't be afraid to say no. If there are things that you don't want to do or you don't think are in line with your mission, have the courage to say, this is probably not the best fit for me, and deal with the consequences later. So it's just reiterating the theme. These are all individual decisions. Now, if we sort of think about the value-based decision making that I'm advocating, when there is a dissonance between your value structure and what your effort is, I think that is a core cause of this burnout concept. So let's say you have an administrative person saying, I would like you to read those cases faster than makes you comfortable because money is good. And let's say you're a radiologist and you say, but excellent care is why I became a doctor. What would this patient think if she knew what I was doing? And this creates this thing called a moral injury. And if you do this over a sustained period of time, it actually wears your soul away. This is a quote by Diane Silver, who was a journalist. And this is in the context of soldiers who have gone to war and had to kill people, despite the fact their entire youth was about, don't kill people. Moral injury is a deep soul wound that pierces a person's identity, their sense of morality, and their relationship to society. And if you think about that moral injury that exists when we're doing something that we know is, or we believe, rather, is not in the best interest of whatever our value structures is, this is what happens, is burnout. So this is the WHO criteria, ICD-11 code. It was in May of 2019 this was released. So burnout is reduced professional efficacy, feelings of energy depletion or exhaustion, and increased mental distance, negativism, and cynicism toward work. And this can result when there is a constant and chronic conflict between your value structure and what you're doing in your workplace. This is Rich Cohan. He's been a mentor of mine for a very long time. He is the greatest of all time. Two little videos from him. So I think there's a tremendous emphasis now being put on wellness, including for radiologists. But I have a lot of concerns about that because some of the wellness efforts, some of the wellness activities that have been recommended are bonding activities among faculty, maybe Grand Rounds lectures about faculty wellness. But I'm really concerned about this because I think that the emphasis is a little bit misplaced. The problem now is that we are just working too hard. And unless we can address that fundamental issue, all of the other surface efforts for wellness are just not gonna be successful. So he thinks that we're becoming busier and busier and busier and that constant stress is a major contributor to why we feel burnt out. Our resources are completely depleted. I think it's really hard to achieve a work-life balance. I think medicine creeps in at all corners of our lives, perhaps even more in academics than in private practice. But it's an issue for everyone. And what I've found is sometimes I have to take emotional breaks and I have to decide for some weeks and maybe for some months that I'm gonna go home and I'm not taking anything with me. And that's a conscious decision, but even that doesn't always work. Otherwise, I think it's a very difficult problem. So he's making intentional choices to free up some of his mental bandwidth and say, I'm not going to work on that because by doing that, it makes me less well-off. We are increasingly resource-constrained. So we have to think strategically. In a time of flush time, maybe 20 or 30 years ago, where in an academic environment, not that I was around at that time, but it's been described to me that one could come in and read out and then go do some academic work and sort of teach at your leisure, but now our resources, us specifically being the resource, because here the precious resource is us. So when our time is constrained, we have to be strategic about how we allocate our time and that allocation is all about work-life balance. It's now much harder to do all the things that maybe people used to do in the past. And this is a cat from Alice in Wonderland. There's a very famous little saying in here. So Alice asks, would you tell me please which way I ought to go from here? And the cat says, well, that depends a good deal on where you want to get to. And Alice says, well, I don't much care where. And the cat interrupts her and says, then it doesn't matter which way you go. So if you're not being intentional about your decision making, then wherever you end up, that's where you are. So ask yourself, where do I want to go? What is necessary for me and what is optional? And the way you answer those questions, I believe, is to again, reference your value system. Use those values to inform these questions so you can make smart choices. So you may be in the audience saying, yeah, fine, don't care. I'm here to learn about how to be successful in academics. So just tell me what I need to do to be successful. So I asked who I consider one of the most successful junior faculty right now. Nellie, she works at Loma Linda, and this is her take. I subscribe to Cal Newport's philosophy on success. And in his book, So Good You Can't Be Ignored, he argues that how good you are now really dictates your next steps and opportunities. And that requires two things, knowledge and metanowledge. You have to have the skills and expertise, the knowledge, but the second step is really understanding the stepping stones, the roadmap to get to where you wanna be. And he published a study that showed that for early career academicians, really the key thing was to publish. And publishing four to five articles per year sort of differentiated those who did really well from those who didn't. And so I've spent the past two years trying to achieve these goals, and it probably came at the expense of wellness but I am working towards now to try to find alignment and strategy for the next steps in my career. This is my daughter who has decided to join us. She just woke up. So that's adorable, I think. There's a few things that I heard Nellie say there. First is how good you are now dictates your next opportunities. So self-assessment's very critical. To emphasize your strengths, you need to know what they are and then take those strengths and create your own value. She also said that knowledge is critical but so too is a strategic plan. What is the intentional path that you are going to take? And that is strategic thinking. Having a path requires a destination in mind. And in this example, Nellie's was, quote, early career academic success. So one intentional pathway or strategy to academic success that she learned about and then applied was here's where I am right now. I need to publish a certain number of papers each year and if I do that, what will happen is I will end up in academic success, whatever that is. But some more things I heard Nellie say was I was being perhaps academically successful but maybe at the expense of wellness. So your strategic plan needs to consider all facets. If your emotional and physical wellness is important to you, factor that into your strategic plan. Don't just solely focus on your academic productivity. So what do you value and what makes you happy? If academic success is what makes you happy, then great. But for a lot of people, that's not enough. So your plan should consider this and just treat it like a strategic plan for a business. So how should you balance workload and academics to achieve emotional wellness? First, answer this question is who are you and what do you value? And then use those answers to develop a strategic plan. You are the constrained resource. Your time is the resource that needs to be allocated. So plot the desired end and be stingy with yourself because there's probably only one of you and no one can define success for you, only you can. So balance must be individually defined. Thank you. Thanks to RS&A for letting me come up here and tell you about my biggest failure. Okay, so I'm Desiree Morgan from UAB and at present, let's see here. I'm the Vice Chair of Education and that's what I am now but it doesn't reflect where I've been. And we've heard some fantastic talks about quality and interactions and your own personal horizon point, et cetera. I'm just gonna show you some pictures of failures that I've been associated with. Here's one, this is gnocchi. If you've ever made it, it's actually the simplest pasta to make. When it doesn't turn out well, you just get this water that fills with potato goo and you have to do it again. So I've failed at gnocchi. This one, and these are not equivalent failures by any stretch of the means, is a 42 year old man who came in with a small cystic lesion in his pancreas. I'm an abdominal imager. I like to think of myself as knowing something about the pancreas. I did not read this particular case but seven years later at the age of 49, he returned with a gigantic malignant IPMN that was now metastatic all throughout his abdomen. Our system failed and I was associated with that because I do research on the pancreas and this is something that I would like to prevent happening and finally, 21 years after receiving this piece of paper from the RSNA when I failed to get a seed grant, I've kept this piece of paper to remind myself of my failure here, not the fact that I didn't get the grant but that I didn't do anything when I didn't get the grant and so these are just examples of things in my life where I have failed but I toss this at you. Someone really brilliant and much smarter than me said, I have not failed. I've just found 10,000 ways that won't work. That was Thomas Edison, very important man in our culture and I would say if you're not failing, you're really not trying. I mean, that's a lot of people have said that before. So why me? Right, this may be your response when you are looking at failure. I don't mean it in that way. I don't mean why me like you get this email back from a journal and you're like, okay, I'm not gonna look at it. Did I get it accepted or rejected? But why me? Why am I here? Do I have a CV of failures? Have y'all ever heard of this topic? I was first introduced to it at the AUR this year. Dr. Haushofer at Princeton, I believe and you can just click on this and look at what a CV of failure is. We have successes on our CVs. If you really want to contemplate where you have been and maybe why your path has not been what you want it to be, make one of these up. He attributes his CV of failure to Dr. Stefan who actually wrote about it in 2010. So I think this is an interesting reflective exercise if you want to check out your CV of failure. Well, I don't have one of these, so it wasn't that that Olga asked me to come talk to you about. I was giving a TED-like talk at another meeting about professional adaptability. And for me, that means in your practice, in your life, you know, we all have, I have a horizon point that I try to strategically make decisions to always maintain, but the path is not straight. And when you come up with choices, some of what Matt was talking about, I think of professional adaptability as, and all my residents, you need to be prepared, right? So you need to be a good clinical radiologist. You need to be prepared to take opportunities. You need to have a willingness to change, to take on a new role in your organization. You need to have the ability to see an opportunity when it's coming or make strides towards making that happen. If you are presented with an opportunity, you negotiate. This has to do with, there's only 24 hours in the day and what's important to yourself. Negotiate to ensure you're gonna have success or to mitigate potential failure. And then finally pulling the trigger to change. So in that talk, I was weaving my story about my path and I get to 25 years into my career, and then I said, and here's my biggest failure. So I think that's why me, that's why I'm up here to talk to you. And not so much about the failure, but what do you do to get out of it? So here's my blank slide and I'm just gonna tell you a story. So I have had different roles in my professional career. I have been at UAB or in the Birmingham area the whole 30 years I've been practicing. And from that, I'm an abdominal radiologist. I was, things you might think of as a young, energetic person, I was an assistant program director. I was in charge of GI at one point. I was the director of MR. I've had different roles, one of which was being the vice chair of clinical research for nine years. And I was reasonably good at that, started some imaging cores, built our research infrastructure up. In the middle of all that, I had actually left and went into private practice for four years because of personal needs of my family. And that was an amazing adventure, going from being an abdominal imager to working at a neuro and musculoskeletal sports health hospital. But my biggest failure came 25 years into my career when I transitioned from being the vice chair of clinical research at UAB to being the vice chair of education, which is what's on my title slide, right? I am still the vice chair of education. I'd went through my normal process of seeing the opportunity, thinking about my preparedness, doing my homework into what I needed to be successful or what I thought I needed to be successful in that role. And I pulled the trigger and I said yes to switching from clinical research, which was all about being outside the box, bringing teams together to do interesting things that people hadn't thought about, to the constraints of what is academic administration. Very different, inside the box, ACGME rules. And I really had been an assistant program director before. I thought I knew a little bit about education. My former, my great mentor had confidence in me to take over that job. I was always very engaged with residents. I thought I could do it, so I said yes. The day after I said yes, the first resident came and told me that she wanted to transfer for personal reasons and I had to write a letter, let her go. The next day, the assistant program director that I was supposed to be bringing up to be the program director, because I didn't just say yes to being vice chair of education, I was to be the program director as well, as I learned how to be vice chair of education, told me she was leaving, so I didn't have her. Within three weeks, I went to the AUR and then the program coordinator quit. Meanwhile, a bunch of other things happened. I learned that the ABMS had just approved IR, so I was responsible for writing all these applications for a whole new residency. I learned about the next accreditation system and all that meant, so I basically got into this downward death spiral of not being very efficient or very good at being either a program director or the vice chair of education, which entailed much more than running a program. Developing two residencies, doing the fellowships, faculty development education, all this stuff. So I became ineffective where I had had before then a pretty successful career, or to myself, I reflected that I had not been successful as this program director. And I think that a lot of what I perceived as being a failure in those roles was because of scarcity, and I wanna talk to you about this concept because it plays into what hasn't been mentioned before in other people's talks today. Scarcity is real or perceived, and I think it's linked to failures, and your ability to climb out of failure. So what is it? If you look at the Merriam-Webster dictionary, it's the quality or state of being scarce, especially want of provisions for the support of life. So that's the real meaning of scarcity. There's an economic meaning of scarcity, and that's where there are limited resources with limitless wants. So it might be that the resources are stable, but the wants go up, the demand goes up, so there's an imbalance. Or the resources go down even though the wants are stable. Or there's something in the system that makes this imbalance. But what I'm talking about is professional or workplace scarcity. And that's when people perceive that there's a lack of something important. When you see, I never have enough time, I just have too many roles, I don't have the resources, I need to have five more people helping me put all this information into ACGME web ads, et cetera. When you get into the scarcity mindset, it limits your cognitive abilities. And you are unable to do the job that normally you would be able to function highly and do. And so it can undermine your ability for your work or for your coworkers to do their jobs, this concept of scarcity. So in our life, it's time. Last I looked, there's still just 24 hours in a day. But you can do something, and so you can't make more time. You can get more resources or get more training and skills to kind of counterbalance this, but there's never gonna be more time. So for me, it was scarcity of time. I could learn how to be a program director. I did. It wasn't pretty, but I did. So here's the other thing. Resilience. When we've talked, no one has said the R word, but it's incredibly important if you're failing or finding yourself in a time of scarcity to have resilience. Because I think of resilience as freedom from the bonds of failure. We all fail, but it's what you do with that failure that makes a difference. That piece of paper from the RS&A R&E grant actually was the critique of how to make my grant better. I just didn't act on it because I didn't really know what it was at the time. So resilience also helps you promote actions that help you climb out of failure. This is what you need, and Merriam-Webster defines it as the ability to recover from or adjust easily to misfortune or change. In psychology today, it's the ineffable quality that allows some people to be knocked down by life and come back at least as strong as before. Okay? So factors that make one resilient, positive attitude, optimism, things we were hearing earlier throughout today, the ability to regulate your emotions, to see a failure as a form of helpful feedback. What did I get from the RS&A? It was helpful feedback. So this is something I absolutely know personally to be true. Scarcity impedes resilience. So if you can identify that this concept of scarcity exists and you could address it, then you can become resilient to climb out of failure. So what did I do? When my decision didn't really work out all that well a couple years in, I knew that I had to find a new program director to do an effective job there so that I could lead in the vice chair position that I had been asked to do. So I looked at it and removed my personal emotions. I got, I read some books. I went to some leadership courses and I looked at it like it was. What is the situation? Why was I failing? It was time. There was too much to do. I probably shouldn't have said yes. I thought I did my homework. I felt very energetic about it, but I looked at it analytically and I looked at why I thought it happened and said, okay, for the next person, I'm gonna set them up with the tools so they can enjoy success, which is exactly what I did. I got that person more dedicated time to be a program director. I changed things around once I was climbing out of my failure and I enacted the plan to alter the trajectory of our whole program and the whole educational system at UAB. If any of my colleagues are here, this is pretty vulnerable, so forgive me and come talk to me later. And I would just say that our program is so much better now once I was able to, and this was like 25 months in, look at this more analytically. I identify the scarcity in time and then figure out what to do about it. And so I suggest that for all your failures, big and small, keep this in perspective and always take a failure as an opportunity to make something better. So I bring this up again. Maybe I don't want 10,000 ways that things won't work, maybe just 579, but here's something else I know to be true, and this gets to what Matt was saying. I'm a big fan of walking on the beach at sunrise. And so this, put my glasses on to read it, is a quote. I get these every day from gratefulness.org and it's giving Tuesday, so be grateful. I think over again my small adventures, my fears, those small ones that seem so big, all those vital things I had to get and to reach, and yet there's only one great thing, to live and see the great day that dawns and the light that fills the world. So whatever you're doing in your professional role and your personal role, when you encounter failure, know that identification of what the problem is and being analytical and pulling yourself out of it once you recognize what the needs are is really important. And thanks for letting me tell my story.

respect

mentorship

radiology

staff performance

patient outcomes

work-life balance

resilience

career satisfaction

interruptions

diverse teams

strategic planning